Dreaming partnership, enabling inequality: administrative infrastructure in global health science

Africa ◽  
2020 ◽  
Vol 90 (1) ◽  
pp. 188-208
Author(s):  
Johanna T. Crane
Keyword(s):  
Global Health ◽  
Science Studies ◽  
Health Science ◽  
Global Health Research ◽  
Power Dynamics ◽  
Financial Risks ◽  
Research Partnerships ◽  
International Partnerships ◽  
Fiscal Administration

AbstractThis article examines the fiscal and administrative infrastructures underpinning global health research partnerships between the US and Uganda, and the power dynamics they entail. Science studies scholars and anthropologists have argued for the importance of studying so-called ‘boring things’ – standards, bureaucracies, routinization, codes and databases, for example – as a way to bring to the surface the assumptions and power relations that often lie embedded within them. This article focuses on fiscal administration as an understudied ethnographic object within the anthropology of global health. The first part of the article is a case study of the fiscal administration of a US–Uganda research partnership. The second part describes the institutionalization of some of the administrative norms and practices used by this partnership within the ‘global health enabling systems’ employed by US universities working in Uganda and elsewhere in Africa. I analyse a case study and ‘enabling systems’ to show how these administrative strategies create parallel infrastructures that avoid direct partnership with Ugandan public institutions and may facilitate the outsourcing of legal and financial risks inherent in international partnerships to Ugandan collaborators. In this way, these strategies act to disable rather than enable (or build) Ugandan research and institutional capacity, and have profound implications for African institutions as well as for the dream of ‘real partnership’ in global health.

scholarly journals Decolonising global health: transnational research partnerships under the spotlight

2020 ◽  
Vol 12 (6) ◽  
pp. 518-523 ◽  
Author(s):  
David S Lawrence ◽  
Lioba A Hirsch
Keyword(s):  
Global Health ◽  
Active Role ◽  
Global Health Research ◽  
Colonial Power ◽  
Critical Perspective ◽  
Research Partnerships ◽  
Health Movement ◽  
Participant Experience ◽  
Core Components

Abstract There are increasing calls to decolonise aspects of science, and global health is no exception. The decolonising global health movement acknowledges that global health research perpetuates existing power imbalances and aims to identify concrete ways in which global health teaching and research can overcome its colonial past and present. Using the context of clinical trials implemented through transnational research partnerships (TRPs) as a case study, this narrative review brings together perspectives from clinical research and social science to lay out specific ways in which TRPs build on and perpetuate colonial power relations. We will explore three core components of TRPs: participant experience, expertise and infrastructure, and authorship. By combining a critical perspective with recently published literature we will recommend specific ways in which TRPs can be decolonised. We conclude by discussing decolonising global health as a potential practice and object of research. By doing this we intend to frame the decolonising global health movement as one that is accessible to everyone and within which we can all play an active role.

scholarly journals Global health research partnerships in the context of the Sustainable Development Goals (SDGs)

2020 ◽  
Vol 16 (11) ◽  
pp. 1614-1618 ◽  
Author(s):  
Joyce Addo-Atuah ◽  
Batoul Senhaji-Tomza ◽  
Dipan Ray ◽  
Paramita Basu ◽  
Feng-Hua (Ellen) Loh ◽  
...  
Keyword(s):  
Sustainable Development ◽  
Global Health ◽  
Health Research ◽  
Sustainable Development Goals ◽  
Global Health Research ◽  
Research Partnerships ◽  
The Sustainable Development ◽  
Development Goals

Towards inclusive priority-setting for global health research projects: recommendations for sharing power with communities

2019 ◽  
Vol 34 (5) ◽  
pp. 346-357 ◽  
Author(s):  
Bridget Pratt
Keyword(s):  
Global Health ◽  
Priority Setting ◽  
Health Research ◽  
Contextual Factors ◽  
Global Health Research ◽  
Power Dynamics ◽  
Research Projects ◽  
Structured Interviews ◽  
Research Priority ◽  
Health Research Priority Setting

Abstract Global health research priority-setting is dominated by funders and researchers, often from high-income countries. Engaging communities that are considered disadvantaged and marginalized in priority-setting is essential to making their voices and concerns visible in global health research projects’ topics and questions. However, without attention to power dynamics, their engagement can often lead to presence without voice and voice without influence. Global health research priority-setting must be designed to share power with such communities to ensure that research projects’ topics and questions reflect the health care and system inequities they face. To better understand what sharing ‘power over’ priority-setting requires, 29 in-depth, semi-structured interviews and one focus group were undertaken with researchers, ethicists, community engagement practitioners and community-based organization staff. The study shows that, before moving ahead with priority-setting for global health research projects, it is vital to assess whether contextual factors necessary for meaningful engagement between researchers and marginalized communities are present or can be built in the research setting. Study findings describe several such contextual factors and 12 features of priority-setting that affect how processes are run, who participates in them, and who influences their outputs. During priority-setting for global health research projects, it is essential to implement ways of sharing power with communities in relation to these features. Study findings describe a multitude of such strategies that are employed in practice. After priority-setting, it is important to demonstrate respect and accountability to communities.

scholarly journals Global health enabling systems

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Johanna T. Crane
Keyword(s):  
Global Health ◽  
Low Income ◽  
Global Health Research ◽  
Political Climate ◽  
Research Partnerships ◽  
Building Capacity ◽  
Daily Work ◽  
Administrative Control ◽  
Creative Accounting ◽  
Self Image

This think piece argues for the importance of administrative and bureaucratic labor –‘mundane’ things – in maintaining US-African global health research partnerships and the power relations within them. The daily work of accounting, compliance, and risk management undertaken by global health ‘enabling systems’ created by US universities contrasts with global health’s heroic self-image and conjures up negative imaginaries of intransigent African bureaucracies, crumbling communication infrastructure, and corruption. These negative imaginaries help to authorize forms of US fiscal and administrative control that may contradict global health’s ethic of partnership and its related goal of ‘building capacity’ in low-income partner nations, as well as feed ‘creative accounting’ practices by both partner entities. Critiquing these inequalities may seem risky in an era of ‘America First’ and threatened cuts to global health funding. In fact, advocating for equity in global health partnerships and prioritizing the building of African institutional capacity are only made more urgent by the current political climate.

scholarly journals Aligning Community Engagement With Traditional Authority Structures in Global Health Research: A Case Study From Northern Ghana

2011 ◽  
Vol 101 (10) ◽  
pp. 1857-1867 ◽  
Author(s):  
Paulina O. Tindana ◽  
Linda Rozmovits ◽  
Renaud F. Boulanger ◽  
Sunita V. S. Bandewar ◽  
Raymond A. Aborigo ◽  
...  
Keyword(s):  
Global Health ◽  
Community Engagement ◽  
Health Research ◽  
Northern Ghana ◽  
Global Health Research ◽  
Traditional Authority ◽  
Authority Structures

scholarly journals How global is global health research? A large-scale analysis of trends in authorship

2021 ◽  
Vol 6 (1) ◽  
pp. e003758
Author(s):  
Michelle C Dimitris ◽  
Matthew Gittings ◽  
Nicholas B King
Keyword(s):  
Global Health ◽  
Low Income ◽  
Health Research ◽  
Large Scale ◽  
Health Science ◽  
Global Health Research ◽  
Middle Income ◽  
Middle Income Countries ◽  
Income Status ◽  
Over Time

Many have called for greater inclusion of researchers from low- and middle-income countries (LMICs) in the conduct of global health research, yet the extent to which this occurs is unclear. Prior studies are journal-, subject-, or region-specific, largely rely on manual review, and yield varying estimates not amenable to broad evaluation of the literature. We conducted a large-scale investigation of the contribution of LMIC-affiliated researchers to published global health research and examined whether this contribution differed over time. We searched titles, abstracts, and keywords for the names of countries ever classified as low-, lower middle-, or upper middle-income by the World Bank, and limited our search to items published from 2000 to 2017 in health science-related journals. Publication metadata were obtained from Elsevier/Scopus and analysed in statistical software. We calculated proportions of publications with any, first, and last authors affiliated with any LMIC as well as the same LMIC(s) identified in the title/abstract/keywords, and stratified analyses by year, country, and countries’ most common income status. We analysed 786 779 publications and found that 86.0% included at least one LMIC-affiliated author, while 77.2% and 71.2% had an LMIC-affiliated first or last author, respectively; however, analagous proportions were only 58.7%, 36.8%, and 29.1% among 100 687 publications about low-income countries. Proportions of publications with LMIC-affiliated authors increased over time, yet this observation was driven by high research activity and representation among upper middle-income countries. Between-country variation in representation was observed, even within income status categories. We invite comment regarding these findings, particularly from voices underrepresented in this field.

scholarly journals Designing Participatory Needs Assessments to Support Global Health Interventions in Time-Limited Settings: A Case Study From Nigeria

2021 ◽  
Vol 20 ◽  
pp. 160940692110024
Author(s):  
Kathleen A. Lynch ◽  
Adeleye D. Omisore ◽  
Olusola Famurewa ◽  
Olalekan Olasehinde ◽  
Oluwole Odujoko ◽  
...  
Keyword(s):  
Global Health ◽  
Needs Assessment ◽  
Program Implementation ◽  
Participant Observation ◽  
Power Dynamics ◽  
Urban Centers ◽  
Social Scientists ◽  
Nigerian Women ◽  
Health Project

Social scientists have advocated for the use of participatory research methods for Global Health project design and planning. However, community-engaged approaches can be time and resource-intensive. This article proposes a feasible framework for conducting a participatory needs assessment in time-limited settings using multiple, triangulated qualitative methods. This framework is outlined through a case study: a participatory needs assessment to inform the design of an ultrasound-guided biopsy training program in Nigeria. Breast cancer is the leading cause of death for Nigerian women and most cases in Nigeria are diagnosed at an advanced stage; timely diagnosis is impeded by fractious referral pathways, costly imaging equipment, and limited access outside urban centers. The project involved participant observation, surveys, and focus groups at the African Research Group for Oncology (ARGO) in Ile-Ife, Nigeria. Through this timely research and engagement, participants spoke about diagnostic challenges, institutional power dynamics, and infrastructure considerations for program implementation.

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